From the Departments of Nuclear Medicine.
Orthopaedic Surgery and Traumatology.
Clin Nucl Med. 2021 May 1;46(5):361-368. doi: 10.1097/RLU.0000000000003545.
Third-generation total ankle replacement (TAR) is an increasingly popular and effective treatment for end-stage osteoarthritis, yet identifying causes of failure remains challenging. We evaluated integrated bone SPECT/CT in recurrent pain after TAR by validating a standardized reporting scheme, identifying uptake patterns, and assessing diagnostic performance and impact on clinical management.
A total of 24 TARs in 16 patients with persistent or recurrent pain received integrated bone SPECT/CT using diagnostic CT settings. Images were retrospectively reviewed, and a novel localization scheme was validated by assessing interrater agreement. Distinct uptake patterns were identified, and diagnostic test characteristics were estimated. Reference standard consisted of clinical follow-up, laboratory findings, and subsequent procedures, including revision surgery.
Standardized scoring of bone SPECT/CT uptake was highly reproducible (intraclass correlation coefficient, 0.79; 95% confidence interval [CI], 0.75-0.82). The final diagnoses were gutter impingement (n = 12), periprosthetic (stress) fracture (n = 5), loosening (n = 5), tarsal arthritis (n = 1), and erysipelas (n = 1). Overall, the diagnostic test characteristics of bone SPECT/CT were as follows: sensitivity of 100% (95% CI, 82%-100%), specificity of 80% (95% CI, 28%-99%), and accuracy of 96% (95% CI, 79%-100%). Gutter impingement, periprosthetic fracture, and loosening were correctly identified in all cases revealing distinct uptake patterns. Importantly, persistent diffuse uptake was frequently observed, warranting cautious interpretation. Bone SPECT/CT impacted clinical management in 86%, with symptomatic improvement in 83% of patients.
Integrated bone SPECT/CT of painful TARs may benefit from standardized localization to reveal distinct uptake patterns representing common complications after TAR. Initial results show highly promising diagnostic value with potentially important impact on clinical management.
第三代全踝关节置换术（TAR）是治疗晚期骨关节炎的一种越来越受欢迎且有效的方法，但确定失败原因仍然具有挑战性。我们通过验证标准化报告方案、确定摄取模式、评估诊断性能以及评估对临床管理的影响，评估了 TAR 后复发性疼痛的整合骨 SPECT/CT。
16 例持续或复发性疼痛的患者共 24 例 TAR 接受了使用诊断 CT 设置的整合骨 SPECT/CT。对图像进行了回顾性审查，并通过评估组内一致性验证了新的定位方案。确定了独特的摄取模式，并估计了诊断测试的特征。参考标准包括临床随访、实验室发现以及随后的程序，包括翻修手术。
骨 SPECT/CT 摄取的标准化评分具有高度可重复性（组内相关系数为 0.79；95%置信区间[CI]，0.75-0.82）。最终诊断为：沟槽撞击（n=12）、假体周围（应力）骨折（n=5）、松动（n=5）、跗骨关节炎（n=1）和丹毒（n=1）。总体而言，骨 SPECT/CT 的诊断测试特征如下：灵敏度为 100%（95%CI，82%-100%），特异性为 80%（95%CI，28%-99%），准确性为 96%（95%CI，79%-100%）。所有病例均正确识别出沟槽撞击、假体周围骨折和松动，呈现出独特的摄取模式。重要的是，经常观察到持续弥漫性摄取，需要谨慎解释。骨 SPECT/CT 影响了 86%的临床管理，83%的患者症状得到改善。
TAR 后疼痛的整合骨 SPECT/CT 可能受益于标准化定位，以揭示代表 TAR 后常见并发症的独特摄取模式。初步结果显示出非常有前途的诊断价值，并可能对临床管理产生重要影响。
